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INTRODUCTION

Children with epilepsy are at risk for cognitive disorders. They experience more academic underachievement and frequently suffer from impaired attention. These problems are found even in those children with epilepsy and a normal intelligence. In this chapter, we will concentrate on school-age children with epilepsy. We will review learning disorders (LD) and attention deficit hyperactivity disorder (ADHD). Additional information on mental retardation can be found in Chapters 27 and 28 and more information on cognitive problems in Chapter 33.

LEARNING AND ADHD

Learning disorders and ADHD will be covered together for several reasons. First, both have significant impact on academic success. While LD quite obviously impacts school performance, ADHD in children with epilepsy may have a similarly negative effect on school performance. Williams et al1 found that ADHD in children with epilepsy was a better predictor of academic difficulties than memory, socioeconomic status, or self-esteem. Second, LD and ADHD are frequently comorbid conditions. Approximately 30–35% of children with ADHD have LD.2 Finally, these two problems initially may be difficult to distinguish. Attention deficit hyperactivity disorder may be mistaken for LD and vice versa. However, treatment of the two disorders is quite different.

Learning disorders must be distinguished from intellectual disability or mental retardation (MR). Intellectual disability is defined as a significantly below average intelligence with IQ scores of 70 or below on standardized, individually administered tests of cognitive function, impairment in multiple areas, and an onset prior to 18 years of age. The IQ score is used to delineate severity levels. Severity levels range from mild MR, with IQ scores of 50–70, to profound MR, with IQ score less than 20 or 25.3

Learning disorders, also called academic skills disorders or learning disabilities, have been defined in two somewhat different ways. The first is the discrepancy model that compares academic achievement to intelligence. In the current DSM-IV-TR, a diagnosis of learning disorders requires scores of achievement on a standardized, individually administered test that are below the level expected for the child's age, intelligence measured by psychoeducational testing, and education.3 The disability must cause impairment and should not be explained by sensory deficits. Categories are reading disorder, mathematics disorder, disorder of written expression, and learning disorder not otherwise specified. Motor skills disorder and communication disorders are separate categories.

A second way of classifying learning disorder uses a below-average performance on a standardized measure of academic performance without regard for the child's intelligence. As an example, if a child had an IQ score 1.5 standard deviation (SD) below normal and a reading achievement score 1.5 SD below normal, the child would be considered to have a reading disorder. The distinction in definition of learning disorder is important practically in the determination of which child receives special education services in a school system.